Anxiety–a story of two powerful mistakes

Why do we have anxiety? We experience anxiety when we want control over outcomes that are important to us. In this sense, anxiety itself is not a problem. A professor back in graduate school had a saying about anxiety: “without anxiety all rabbits would be dead on the railroad tracks” (if they didn’t jump like mad off the tracks when they heard the train, they’d get hit–and be dead). Just like rabbits, we need anxiety to motivate us to take care of important issues, to avoid certain kinds of problems, to make us aware of potential dangers, to get us thinking really hard about things we need to do and not do.

In fact, like anger and conflict (see my other posts about those issues), anxiety is an inevitable, and often just plain necessary, part of life. So, anxiety is not good or bad, and we need to be sure to separate what’s normal and healthy anxiety from what becomes a problem to deal with in therapy. Anxiety becomes a problem when it is no longer helpful and is harmful to the person experiencing the anxiety. This kind of harm can come in many different “flavors”–as in “panic attacks,” which have a fairly specific set of prescribed attributes including a number of physical symptoms, but which may be related to any number of different triggers, or apparently no identifiable trigger at all. There are forms of anxiety and fear about very specific kinds of situations, which are called “phobias.” Most people are familiar with the more common phobias, including “agoraphobia” (fear of leaving your house or being in public), arachnophobia (fear of spiders), and social anxiety (fear of social situations).

The most common form of anxiety among my clients, and perhaps most therapy clients, is given the name “Generalized Anxiety Disorder,” which essentially means a lot of worrying about a lot of different topics, that the client finds difficult to control, and which comes with a variety of other symptoms such as sleeplessness, fatigue, irritability, edginess, etc.

As in most of my blogs categorized as “therapy insights” (like this one), I look for common threads among my clients to try to see patterns in how certain kinds of problems occur, and if possible how they can be solved. Anxiety seems to be the result of one or both of two kinds of mistakes about control: (1) “I must control something over which I actually have no control; and (2) I do not have control over something that I need to control.

The most common mistake is the first kind, and its most common flavor is when someone thinks they must have control over another person. Of course, in most circumstances, we have no control over others. And even when we do (as in a parent controlling their child), our level of control is far less than what we often think it is, or should be. So, when we convince ourselves that we must have control over someone else, but in fact we do not and cannot have that control, we stew about what will happen without that control. An example is when we do not want our primary relationship partner to act in a certain way (don’t leave us, stop gambling or drinking or smoking). We try to control them, we cannot control them, we worry alot about not being able to control them.

The second kind of mistake is less common, and is sometimes more difficult to identify in therapy, but is often just as much of a problem. This mistake involves thinking we do not have control over something we think we really need to have control. A simple example is a social phobia–we are afraid of social situations because we cannot control what others think of us, we aren’t sure what we should say or do, who to talk to, and in the end we might get rejected no matter what we do. The mistake is actually often two mistakes. First, we think we need to control what others think of us, when in fact we do not. The chance of rejection is often far less likely than we tell ourselves as we are getting ready for the party. And if we do get some kind of rejection, it is often no big deal. Second, we have more control than we think we do. We know how to talk, to smile, to dress more or less appropriately, to shake hands, make eye contact when we are supposed to, but we might tell ourselves that we are going to flub it up, that we don’t know how to do these basic things. These basic things are probably 95% of what we need to do in a social situation to avoid gaffs and be a presentable and enjoyable participant. These things give us nearly all the control we need in order to avoid what we fear: rejection.

So, what can be done about this in therapy, or outside of therapy? As in all things therapeutic, recognize the problem, where it comes from, which mistake is going on, is it one or the other or both? Why do we make this mistake, where did it originate, childhood, a past relationship, an addiction issue? When do we make the mistake? What situations or triggers cause us to make the mistake leading to problematic anxiety? And finally, and perhaps most importantly, when is our anxiety helpful (because most of the time it is) and when does it become a problem, harming us or our relationship with excessive and needless worry and avoidance?

After recognizing the source and causes of problematic anxiety, we can begin to re-think our “need” to control things or situations and our ability to control things or situations. One very basic solution to most (but not all) situations with anxiety is to know that what you have most control over is yourself, your reactions, your decisions, and least control over others. Sounds simple, and it can be, but that doesn’t mean its easy!

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on Thursday, January 14th, 2010 at 9:40 am and is filed under Therapy Insights.
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